Affidavit of Discrepancy: I, - , of Legal Age, Filipino, Single, and A Resident of

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Republic of the Philippines)

City of Cebu ) S.S.


x - - - - -- - - - - - x

AFFIDAVIT OF DISCREPANCY

I, ________________, of legal age, Filipino, single, and a resident of


Poblacion, Cordova, Cebu after having been duly sworn to in accordance
with law do hereby declare THAT:

1. The name erroneously appearing in my school records and other public


documents is __________________;

2. The correct name as per my PSA Certificate of Live Birth is


__________________;

3. The discrepancies are due to pure inadvertence in filling up in my


school records and other public documents and I never intended to
confuse or defraud anybody in using _______________;

4. From now on, I will be using _________________ as my correct and


proper complete name;

5. In view of the foregoing, I am constrained to execute this affidavit


to attest to the truth or veracity of the facts herein above-stated;

IN WITNESS WHEREOF, I have set my hand this ______________, in


Cebu City, Philippines.

_____________________
Affiant

SUBSCRIBED AND SWORN to before me, this _____________________


in Cebu City by the Affiant whom I have identified through competent
evidence of identity by way of ____________.

Page No.: _____;


Page No. : _____
Book No.: _____;
Series of: 2020.

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